Provider Demographics
NPI:1871642231
Name:LOCKWOOD, GEORGE KEITH (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:KEITH
Last Name:LOCKWOOD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 W SOUTH ST STE 41C
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-4673
Mailing Address - Country:US
Mailing Address - Phone:269-345-8100
Mailing Address - Fax:269-345-8262
Practice Address - Street 1:471 W SOUTH ST STE 41C
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-4673
Practice Address - Country:US
Practice Address - Phone:269-345-8100
Practice Address - Fax:269-345-8262
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011315103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680C946330OtherBCBS NUMBER
MIP108015OtherBCN
MI680C946330OtherBCBS NUMBER